Appendix B: Sample Inspection Report

Instructions

This sample inspection report has been developed as a helpful tool to aid you in completing your site inspections. This sample inspection report was created consistent with EPA’s Developing Your Stormwater Pollution Prevention Plan. You can find both the guide and the sample inspection report (formatted in Microsoft Word) at www.epa.gov/npdes/swpppguide

This inspection report is provided in Microsoft Word format to allow you to easily customize it for your use and the conditions at your site. You should also customize this form to help you meet the requirements in your construction general permit related to inspections. If your permitting authority provides you with an inspection report, please use that form.

For more information on inspections, please see Developing Your Stormwater Pollution Plan Chapters 6 and 8.

Using the Inspection Report

This inspection report is designed to be customized according to the BMPs and conditions at your site. For ease of use, you should take a copy of your site plan and number all of the stormwater BMPs and areas of your site that will be inspected. A brief description of the BMP or area should then be listed in the site-specific section of the inspection report. For example, specific structural BMPs such as construction site entrances, sediment ponds, or specific areas with silt fence (e.g., silt fence along Main Street; silt fence along slope in NW corner, etc.) should be numbered and listed. You should also number specific non-structural BMPs or areas that will be inspected (such as trash areas, material storage areas, temporary sanitary waste areas, etc).

You can complete the items in the “General Information” section that will remain constant, such as the project name, NPDES tracking number, and inspector (if you only use one inspector). Print out multiple copies of this customized inspection report to use during your inspections.

When conducting the inspection, walk the site by following your site map and numbered BMPs/areas for inspection. Also note whether the overall site issues have been addressed (customize this list according to the conditions at your site). Note any required corrective actions and the date and responsible person for the correction in the Corrective Action Log.

Stormwater Construction Site Inspection Report

General Information
Project Name
NPDES Tracking No. / Location
Date of Inspection / Start/End Time
Inspector’s Name(s)
Inspector’s Title(s)
Inspector’s Contact Information
Inspector’s Qualifications / Insert qualifications or add reference to the SWPPP. (See Section 5 of the SWPPP Template)
Describe present phase of construction
Type of Inspection:
q Regular q Pre-storm event q During storm event q Post-storm event
Weather Information
Has there been a storm event since the last inspection? qYes qNo
If yes, provide:
Storm Start Date & Time: Storm Duration (hrs): Approximate Amount of Precipitation (in):
Weather at time of this inspection?
q Clear qCloudy q Rain q Sleet q Fog q Snowing q High Winds
q Other: Temperature:
Have any discharges occurred since the last inspection? qYes qNo
If yes, describe:
Are there any discharges at the time of inspection? qYes qNo
If yes, describe:

Site-specific BMPs

·  Number the structural and non-structural BMPs identified in your SWPPP on your site map and list them below (add as many BMPs as necessary). Carry a copy of the numbered site map with you during your inspections. This list will ensure that you are inspecting all required BMPs at your site.

·  Describe corrective actions initiated, date completed, and note the person that completed the work in the Corrective Action Log.

/ BMP / BMP Installed? / BMP Maintenance Required? / Corrective Action Needed and Notes /
1 / qYes qNo / qYes qNo
2 / qYes qNo / qYes qNo
3 / qYes qNo / qYes qNo
4 / qYes qNo / qYes qNo
5 / qYes qNo / qYes qNo
6 / qYes qNo / qYes qNo
7 / qYes qNo / qYes qNo
8 / qYes qNo / qYes qNo
9 / qYes qNo / qYes qNo
10 / qYes qNo / qYes qNo
11 / qYes qNo / qYes qNo
12 / qYes qNo / qYes qNo
13 / qYes qNo / qYes qNo
14 / qYes qNo / qYes qNo
15 / qYes qNo / qYes qNo
16 / qYes qNo / qYes qNo
17 / qYes qNo / qYes qNo
18 / qYes qNo / qYes qNo
19 / qYes qNo / qYes qNo
20 / qYes qNo / qYes qNo

Overall Site Issues

Below are some general site issues that should be assessed during inspections. Customize this list as needed for conditions at your site.

/ BMP/activity / Implemented? / Maintenance Required? / Corrective Action Needed and Notes /
1 / Are all slopes and disturbed areas not actively being worked properly stabilized? / qYes qNo / qYes qNo
2 / Are natural resource areas (e.g., streams, wetlands, mature trees, etc.) protected with barriers or similar BMPs? / qYes qNo / qYes qNo
3 / Are perimeter controls and sediment barriers adequately installed (keyed into substrate) and maintained? / qYes qNo / qYes qNo
4 / Are discharge points and receiving waters free of any sediment deposits? / qYes qNo / qYes qNo
5 / Are storm drain inlets properly protected? / qYes qNo / qYes qNo
6 / Is the construction exit preventing sediment from being tracked into the street? / qYes qNo / qYes qNo
7 / Is trash/litter from work areas collected and placed in covered dumpsters? / qYes qNo / qYes qNo
8 / Are washout facilities (e.g., paint, stucco, concrete) available, clearly marked, and maintained? / qYes qNo / qYes qNo
9 / Are vehicle and equipment fueling, cleaning, and maintenance areas free of spills, leaks, or any other deleterious material? / qYes qNo / qYes qNo
10 / Are materials that are potential stormwater contaminants stored inside or under cover? / qYes qNo / qYes qNo
11 / Are non-stormwater discharges (e.g., wash water, dewatering) properly controlled? / qYes qNo / qYes qNo
12 / (Other) / qYes qNo / qYes qNo

Non-Compliance

Describe any incidents of non-compliance not described above:

CERTIFICATION STATEMENT

“I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fine and imprisonment for knowing violations.”

Print name and title: ______

Signature:______Date:______

EPA SWPPP Inspection Report, Version 1.1, September 17, 2007 1